Vesna Jaksic

Glutathione S‐transferase omega‐2 polymorphism Asn142Asp modifies the risk of age‐related cataract in smokers and subjects exposed to ultraviolet irradiation

Glutathione S‐transferase omega‐1 and 2 have a unique range of enzymatic activities, including the regeneration of ascorbate by their dehydroascorbate reductase activities. Because these enzymes could have a protective role from oxidative damage in the lens, the question of whether the two coding glutathione S‐transferase omega polymorphisms confer the risk of age‐related cataract was addressed.

Clinical Features of Ocular Sarcoidosis in Patients with Biopsy-proven Pulmonary Sarcoidosis in Serbia

ABSTRACT Purpose: To analyze clinical characteristics of ocular sarcoidosis in a group of biopsy-proven sarcoid patients treated at the single referral center for sarcoidosis in Serbia. Methods: A prospective study carried out on 88 biopsy-proven sarcoid patients between January 2012 and December 2014. All patients underwent complete ophthalmological examination. Results: Ocular sarcoidosis was present in 32 patients (36.4% of all) and included: eyelid skin lesions (2.3%); orbital inflammation (2.3%); conjunctival lesions (7.9%); anterior uveitis (2.3%); intermediate uveitis (1.1%); posterior uveitis (15.9%); panuveitis (5.7%), and neuro-ophthalmologic manifestations (9.1%). Complications included cataract (20.4%); glaucoma (5.7%); cystoid macular edema (3.4%); epiretinal membrane formation (4.5%); macular atrophy (2.3%); and choroidal neovascularization (1.1%). Binocular visual impairment was present in one patient (1.1%), due to complications of posterior uveitis (macular scars). Conclusions: Patients in Serbia demonstrated ocular sarcoidosis as the first most common site of extrapulmonary sarcoid manifestations, with more often neuro-ophthalmologic lesions than in other European populations.

Discrete eyelid swelling caused by live subconjunctival Dirofilaria repens

We present a case concerning a 48 year-old man, who had complaints about ocular pains and an unpleasant feeling, which had started two days before admission. It was as if there was “something moving in his left eye.” The examination showed an extremely motile white worm, which was wrapped in concentric circles around the limb in the subconjunctival space of the patient’s left eye. It was identified as the adult female form of Dirofilaria repens. The patient had a normal clinical finding, except eosinophilia. Ocular filariasis is as a possibility to think about, even when the cases are not in a typically endemic area and with no specific subjective complains.

Oxidative stress in association with risk factors for the occurrence and development of age-related macular degeneration

Niz rezultata potvrđuje ulogu oksidativnog stresa u etiopatogenezi AMD i to bilo kao inicijalnog ili izolovanog uzrocnog faktora, ili kao dodatnog cinioca u sklopu drugih faktora rizika. Bolje poznavanje ove oblasti prosiruje mogucnosti prevencije ove, ali i drugih bolesti starijeg životnog doba.

Retinal ganglion cell/inner plexiform layer thickness in patients with Parkinson’s disease

Introduction: The aim of the paper was to analyze the changes in the macular ganglion cell layer and inner plexiform layer (GCL-IPL) thickness in patients with Parkinsons disease. Material and methods: The study enrolled 46 patients with established diagnosis of Parkinsons disease and 46 healthy subjects. Both groups were age- and gender-matched. An OCT protocol, namely standardized Ganglion Cell Analysis algorithm was used to measure the thickness of the macular GCL-IPL layer. The average, minimum, and six sectoral (superotemporal, superior, superonasal, inferonasal, inferior, inferotemporal) GCL-IPL thicknesses were measured from the elliptical annulus centered on the fovea. Results: The mean value of the clinical severity of Parkinsons disease was between 2 and 3, according to the Hoehn and Yahr scale. Statistically significant thinning of the GCL-IPL layer was registered in average and minimum GCL-IPL thickness, as well as in the sectoral layer thicknesses in patients with Parkinsons disease in comparison to the controls. There was no correlation between structural changes in the retina and disease duration or severity. A statistically significant difference in thickness between the different stages of the disease was registered only in the inferior sector. Conclusions: Parkinsons disease is accompanied by thinning of the GCL-IPL complex of macula even in the earliest stages. This may indicate a possible retinal dopaminergic neurodegeneration. There is no correlation between duration or severity of Parkinsons disease with thinning of the GCL-IPL complex. .

Foveal Avascular Zone in Normal Tension Glaucoma Measured by Optical Coherence Tomography Angiography

Aim To measure diameter of foveal avascular zone (FAZ), FAZ area, and vessel density using Optical Coherence Tomography Angiography (OCT-A) in patients with normal tension glaucoma (NTG) and to establish the possible role of OCT-A in diagnosis and follow-up of patients with NTG. Methods Twenty-one eyes of 21 patients with NTG and 30 eyes of 30 healthy subjects underwent complete ophthalmic examination as well as OCT-A on ZEISS AngioPlex. 3 × 3 macula scans were used to measure vertical, horizontal, and maximum diameter of FAZ by two graders. Mean values and interobserver variability were analyzed. Image J was used for analysis of FAZ area and vessel density. Results Mean vertical diameter (t = 5.58, p < 0.001), horizontal diameter (t = 3.59, p < 0.001), maximum diameter (t = 5.94, p < 0.001), and FAZ area (t = 5.76, p < 0.001) were statistically significantly enlarged in the NTG group compared to those in the control group. Vessel density (t = −5.80, p < 0.001) was statistically significantly decreased in the NTG group compared to that in the control group. Conclusion OCT-A could have an important role in the future in diagnosis of patients with NTG. In patients with NTG, there is larger FAZ area, while the vessel density is reduced in comparison to the control group.

Vitreoretinal interface changes after uncomplicated phacoemulsification

Online first: January 30, 2018 SUMMARY Introduction/Objective The aim of this work was to examine the incidence of posterior vitreous detachment (PVD) after uncomplicated phacoemulsification, as well as the importance of optical coherence tomography (OCT) in detecting early changes on vitreoretinal interface. Methods PVD was evaluated in 120 eyes of 120 patients aged between 50 and 70 years by the combination of OCT and ultrasonography immediately prior and one, six, and 12 month after the phacoemulsification cataract surgery with intraocular lens implantation. Results The mean age was 57 ± 8.8 years in female and 58.6 ± 8.8 years in male subjects. The progress statuses were compared after cataract surgery at three time-points: after one, six, and 12 months. Significant progression of PVD in time was confirmed (χ2 = 78.32, p < 0.001). The Wilcoxon test determined that after six months (p < 0.001) and 12 months (p < 0.001) the disease progression was statistically significant in comparison to measurements after one month. In addition, after 12 months, in relation to progression status established after six months, there was significant progression of the disease (p < 0.001). Conclusion Vitreous body detachment after phacoemulsification surgery is common, and OCT plays a very important role in detecting initial changes on the vitreoretinal interface.

The frequency of secondary glaucoma in patients with iridocorneal endothelial syndrome in correlation to the presence of uveal ectropion

Introduction/Objective Iridocorneal endothelial (ICE) syndrome incudes 3 clinical forms: progressive iris atrophy, Chandler’s syndrome, and Cogan–Reese syndrome. It is characterized by various degrees of iris atrophy, corneal endothelial changes, uveal ectropion, corectopia, peripheral anterior synechiae (PAS) and secondary glaucoma. The aim of the study was to illustrate forms of ICE syndrome, determine frequency of secondary glaucoma with emphasis on cases with uveal ectropion, analyze response to medicament treatment and the need for surgical treatment in intraocular pressure (IOP) control. Methods Patients underwent slit lamp examination, applanation tonometry, gonioscopy, ophthalmoscopy, Humphrey visual field testing and Heidelberg retina tomography. Patients were divided into two groups: group I, without uveal ectropion (22 patients) and group II, with uveal ectropion (14 patients). Results A total of 36 patients were examined in a 10-year period. The average age was 38 years, male to female ratio 1:2. Secondary glaucoma was confirmed in 26 (72.2%) patients, out of which 12 (54.5%) in group I and 14 (100%) in group II. PAS were more frequent in group II. In group I, mean initial IOP was 37 mmHg, and after medicament treatment 26 mmHg. Secondary glaucoma was controlled in 50% and remaining 50% underwent surgical treatment. In group II, mean initial IOP was 49 mmHg, and after medicament treatment 32 mmHg. All 14 patients (100%) underwent surgical treatment in order to achieve IOP control. Conclusion ICE syndrome is a rare, progressive disease, with high incidence of secondary glaucoma, which is more frequent in cases with uveal ectropion. In these cases, medicament treatment is not effective and trabeculectomy with antimetabolite application is necessary.

Efficacy of infliximab in treatment of refractory panuveitis associated with Behçet disease

Introduction Behçet disease (BD) is a chronic multi-system disorder with manifestations in the ocular, urological, articular, and vascular systems. Tumor necrosis factor alpha is believed to play a pivotal role in BD. Therapeutic blockade of its activity by infliximab is a novel therapeutic approach and has successfully led to remission of the disease. The aim is to report two cases of refractory BD-associated panuveitis (PU) treated with infliximab. The patients were followed for 12 months. The main therapy assessment parameters were the best corrected visual acuity (BCVA) in the better eye, slit lamp and fluorescein angiography (FAG) from baseline findings and from the final examination. Case outline A male patient (45 years old, 25 years of BD history) and a female patient (45 years old, 15 years of BD history), both with posterior synechia, 3+ flare and complicated cataract, while the female also had hypopyon, were treated with infliximab administered at the dose of 5 mg/kg at weeks 0, 2, 6, and 14. The results for the male patient were as follows (baseline vs. the final examination): BCVA – 0.5 vs. 0.8; cellular reaction – 3+ vs. 1+; FAG – 1/2 vs. 0. The results for the female patient were as follows: BCVA – 0.1 vs. 0.3; FAG – 2/3 vs. 0. After 12 months, relapses or side-effects were not observed. Conclusion Infliximab is an effective and promising drug in treating refractory BD-associated PU. It promptly reduces acute symptoms of PU, but it still remains to be seen if a long-term remission in a great number of patients will be achieved.

Ganglion Cell-Inner Plexiform Layer Thickness in Different Glaucoma Stages Measured by Optical Coherence Tomography

Aim: To compare ganglion cell (GCL) and inner plexiform layer (IPL) thickness in patients at different stages of primary open-angle glaucoma (POAG), determine their sensitivity and specificity values, and correlate thickness values with mean deviations (MD). Methods: This prospective, cross- sectional study was conducted in a group of patients with confirmed POAG who were compared to an age- and gender-matched control group. Glaucomatous damage was classified according to the Hodapp-Parrish-Anderson scale: glaucoma stage 1 (early), glaucoma stage 2 (moderate), and glaucoma stage 3 (severe). The average, minimum, and all 6 sectoral (superotemporal, superior, superonasal, inferonasal, inferior, and inferotemporal) GCL + IPL thicknesses were measured and compared between groups. Results: The average GCL + IPL thickness of 154 eyes of 93 patients in glaucoma stages 1, 2, 3, and 94 eyes of 47 persons in the control group were 76.79 ± 8.05, 65.90 ± 7.92, 57.38 ± 10.00, and 86.01 ± 3.68 μm, respectively. There were statistically significant differences in the average, minimum, and all 6 sectoral GCL + IPL values among the groups. The areas under the receiver operating characteristic curve for average and minimum GCL + IPL thickness values were 0.93 and 0.94, respectively, sensitivity 91.5 and 88.3%, and specificity 98.9 and 100%, respectively. Both thickness values showed significant correlations with MD. Each micrometer decrease in the average GCL + IPL thickness was associated with a 0.54-dB loss in MD. Conclusion: GCL + IPL layer thickness is a highly specific and sensitive parameter in differentiating glaucomatous from healthy eyes showing progressive damage as glaucoma worsens. Loss of this layer is highly correlated with overall loss of visual field sensitivity.